Provider Demographics
NPI:1447845284
Name:RENKEN, ELENA J (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:J
Last Name:RENKEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 WINCHESTER AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1978
Mailing Address - Country:US
Mailing Address - Phone:406-223-0221
Mailing Address - Fax:
Practice Address - Street 1:392 MERROW RD STE E
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3974
Practice Address - Country:US
Practice Address - Phone:860-830-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty